1. Field of the Disclosure
The present invention relates to electronic health records, and in particular to electronic lab test records and providing interoperability when the electronic lab test records are in different formats.
2. Description of the Related Art
A reliable and secure transmission of data between a lab and a laboratory information system (“LIS”) and then from the LIS to a care practitioner (doctor, nurse, etc.), all within a particular institution, is commonly employed in the healthcare field. For a period of time, such data transmission was limited to transferring a “picture” of the document. However, today, electronic transfer of data is the norm inside an institution. Within an institution, the client (care provider) may execute or employ a single program allowing electronic exchange of data, but may be restricted to staying within the closed institutional system, thus forming the LIS. Outside this limited circle, export of lab results is achieved only by sending an electronic PDF, sending a physical copy by postal service, or by facsimile. The different formats precludes integration of the data into a spreadsheet allowing comparisons over time. In order to achieve a single spreadsheet or document containing results from different laboratories, manual intervention for entry and reconciliation of the data is typically required.
In view of the above, with an increasing frequency, a patient may carry physical copies of lab test results performed by different healthcare providers between the various care providers for review by a healthcare professional, and, therefore, the physical copies cannot be displayed on a common platform with data obtained within a hospital. Further. when a patient seeks lab tests performed by an outside facility, the format and/or platform may be different from the format and platform of the in-house laboratory or LIS.
For example, an anaesthesiologist in charge of a pre-op outpatient consultation may read the lab test results on a paper form brought by the patient or transmitted directly from an outpatient laboratory. The lab results may be provided by fax or through electronic format, such as a PDF image, and usually will be printed in the office of the outpatient doctor. Even if electronic transmission of in-house lab test results are provided to the doctor, there is commonly some incompatibility with the results of the test performed outside of the hospital. In this case, it may not be feasible to display results from various facilities in a single format for the healthcare provider to use.
Furthermore, as far as chronic patients are concerned, the situation is even worse. Frequent back-and-forth transfers and orders (different lab tests) occur in the scope of shared follow-up among a highly specialized tertiary center and a local physician (family, general practitioner, etc.). Accordingly, a high volume of transfer of lab test results may be seen in both directions, from the tertiary center to the local physician, and vice versa. The same limitations described above remain. Thus, it is typically not feasible to consolidate the results of both sources automatically on a single electronic spreadsheet. A similar result occurs in collaborative diagnosis, where different actors cannot reconcile their own lab test results with the results of other members of the collaboration.
Clinical assessment, for example in the above approaches to healthcare, benefits from an ontological approach which, in the first half of the 20th century, lead to classify diseases (evolutionary classifications “ICD”, current version #10) and to enhance searches by using significant wording (SNOMED being the most popular among numerous vertical applications). However, these solutions of providing a common language have limitations. As far as clinical data are concerned, taxonomy of symptoms or diseases is directed to a discouraging exhaustiveness for the end-user, as there are several hundreds of thousands references in SNOMED.
As far as biology is concerned, a standard has emerged with Health Level 7 (HL7). HL7 is an organization involved in the development of international standards in healthcare. It provides a framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information. These data standards are meant to permit healthcare providers to share clinical information efficiently. Within HL7, there are, for example, conceptual standards (HL7 RIM), document standards (HL7 CDA), application standards (HL7 CCOW), and messaging standards (HL7 v2x and v3 series). The current versions of HL7 in use include HL7 2.5 and HL7 3.0, the latter integrating a bridge with the Digital Imaging and Communications in Medicine format. The European version, named HPRIM, although in use, is being phased out because partial conversion between formats is easily achieved.
Even with the advent of HL7, the above described compatibility issues, and limitations within a single institution, arise, in part, from the existence of an additional layer. In addition to the standards just described, there arises a problem with use of vocabulary, even within the single HL7 format. For instance, in lab results, “red blood cell” may be described under ten or so different representations as well as homonyms, synonyms, and/or acronyms, namely: Red Blood Cell(s), Red blood cell(s), red blood cell(s), Erythrocyte(s), erythrocyte(s), Hemocyte(s), hemocyte(s), RBC, Rbc, and Red BC, among others. Furthermore, legacy versions and non-complying formats also exist and are in use.